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c L'EMERGENCY MANAUCMENT AGENCY
<br />CERTIF1CA1ONS REGARDING LOBBYING; DEBARMENT, SUSPENSION AND
<br />OTHER RESPONSIBILITY MATT cRS; AND DRUG -FREE WORKPLACE REQUIREMENTS
<br />Applicants should refer to the regulations cited below to determine the certification to which tkey are required to attest.
<br />Applicants should also review the instructions for certification included in the regulations before completing this form.
<br />Signature of this form provides for compliance with certification requirements under 44 CFR Part 18, "New Restrictions
<br />on Lobb, irg' and 28 CFR Part I7, "Government -wide Debarment and Suspension (Nonprocurement) and Government.
<br />wide Requirements for Drug -Free Workplace (Grants)." The certifications shall be.treated as a material representation
<br />of fact upon which reliance will be placed when the Federal Emergency Management Agency (F&MA) determines to
<br />award the covered transaction, grant, or cooperative agreement.
<br />1. LOBBYING
<br />As required by section 1352. Title 31 of the U.S. Code, and
<br />implemented at 44 CFR Part 18, for persons entering into a
<br />grant or cooperative agreement over S 100.000, as defined at
<br />44 CFR Par, 18, the applicant certifies :hat:
<br />(a) No Federal appropriated funds have been paid or will be paid, by or
<br />on behalf of the undersigned, to any person for influencing or
<br />attempting- to mftuence an officer or employee of any agency, a
<br />Member of Conoress, an officer or employee of Congress, or an
<br />employee of a Member of Congress in connection with the makino of
<br />jany Federal grant. the entering into of any cooperative agreement, and
<br />the extension, continuation, renewal, amendment, or modification of
<br />any Federal grant or cooperative agreement;
<br />(b) If any other funds than Federal appropriated funds have been paid or
<br />will be paid to any.person tor- influencing or a- empting to influence an
<br />officer or employee of any agency, a Member of Congress, an officer or
<br />an employee of Congress, or employee of a member of Congress in
<br />tonne_ ion with this Federal grant or cooperative agreement, :he
<br />undersigned shall complete and submit Standard Form- LLL.'Disclosure
<br />of Lobbying Activities.' in accordance with its instructions;
<br />(c) The undersioned shall require that the language of this certification
<br />be included in the award documents for all subawards at all tiers
<br />(including subgranu, contracts under grants and cooperative
<br />agreements, andsubcontrac -s) and that all subrecipients shall certify and
<br />disclose accordinoly.
<br />I Standard Form- -Disclosure of Lobbying Activities- arached.
<br />T his form must be a-aciied to certification if nonapproariarec f.n;s
<br />are to be used to infiverce actwitie_)
<br />2. DEBARMENT, SUSPENSION, AND OTHER
<br />RESPONSIBILITY MA j i ERS
<br />(DIREiT RECIPIENT)
<br />As repuired by Executive Order 12549. Debarment and Suspension, and
<br />molemented a: 4t C-rR Par, 67, for prospe =ive participants in primary
<br />covered transactions, as defined at = CFR Part 17, Section 17 S 10-A.
<br />Tne appiicar.. certifies trat it and its principaLr:
<br />(a) Are not presently debarred. suspended. proposed for debarment.
<br />declared ineligible, sentenced to a denial of Federal benefits by a Save
<br />or Federal tour,, or volurtarfiy excluded from covered transactions by
<br />any Federai department or agency;
<br />(b) Have no: within a three -year period preceding this application been
<br />convicted of or had a civilian judgment rendered against them for
<br />commission of fraud or a criminal offense in connection with
<br />FEM_ Form 20.16C JUN 94
<br />obtaining, attempting to obtain, or performm, a public (Federal. State,
<br />or locan transaction or contract under a public transaction; violation
<br />of Federal or State antn:rust statutes or commission of
<br />embezzlement, theft, forgery, bribery, falsification or destruction of
<br />records, making false statements, or receiving stolen property;
<br />(c) Are not presently indicted for or otherwise criminally or civilly
<br />charged by a governmental entity (Federal, -Stare, orlocal) with
<br />commission of any of the offenses enumerated in paragraph (1)(b)
<br />of this certification; and
<br />(d) Have not within a three -year period preceding this application
<br />had one or more public transactions (Federal, State, or local)
<br />terminated for cause or default; and -
<br />E. where the applicant is unable to certify to any of the statements
<br />in this certification, he or she shall attach an explanation to tnis
<br />application.
<br />3. DRUG-FREE WORKPLACE
<br />(GRANTEES OTHER THAN INDIVIDUALS)
<br />As required by the Druc -Free workplace Act of 19BB, and
<br />implemented at r_c C-R Par, 17, Subpar, F. for grantees. as aefined
<br />a-, Ac CFR Par, 17 Sections 17.615 and 17.620-
<br />A. The applicant certifies that it will continue to provide a druc -
<br />free workplace by;
<br />(a) Publishing a statement notifying employees that the unlawful
<br />manufacture, distriout.cn, dispensing, possession, or use of a
<br />controlled subsarce is prohibited in the orantee's workplace a-..;'
<br />specifying the actions sat will be taken against. empio••ec-s for
<br />violation of sup prurimr- -ion;
<br />(b) Establishing an on -going drug free awarenc:s prcoram to
<br />inform employees about-
<br />(1) The dancers of druc abuse in the workplace;
<br />(2) The grantee's policy of mainainine a drug-free workplace;
<br />(3) Any available druc counseling, rehabilitation, and
<br />employee assirance programs; and
<br />(4) The penalties tna; may be imposed upon employees for
<br />druc abuse vio!a;ions occurring in the workplace;
<br />(c) Makinc a a reouiremem—rhat each employee to be engaged in
<br />the performance of the gran: to be oiven a ccpy of the ratement
<br />required by paracr aph (a);
<br />(d) Notifying the employee in the statement required by
<br />paragraph (a)tnat, as a condition of emplovment under the orart,
<br />the employee will-
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